I could use your help please!

[climber1959]

Diagnosed with metastatic prostate cancer in summer of 2022, including soft tissue, even though PSA only 9. Did triple therapy and brain SRT with the Duke Cancer Center in 2022.

Biopsied and tested - only mutation is CDC73, which doesn’t seem to mean much in prostate cancer. High NY-ESO-1, which also doesn’t seem to be very actionable at this time.

Have remained on Lupron and Zytiga. Have had stable scans since end of chemo, with a PSA at .01 or below (though there is some question about how reliable PSA is in my case). MO said about 1% of metastatic cancer patient's PSA is not a good indicator of their cancer status.

CEA began rising in summer of 2024. In October, with CEA in 60’s, MO suggested we begin Pluvicto. PSMA scans are highly concordant with FDG scans.

Have had two treatments since then. Scans show slight decrease in some lung spots, but not in other lung spots, and no change in bones. CEA continues to rise (128 yesterday).

Has anyone else had a tepid response to Pluvicto with first couple of treatments, but then it improved? Has anyone had a CEA that continued to rise while on Pluvicto? Thoughts? I see my MO next week. He has indicated he would like to continue with Pluvicto. I’m wondering if it’s non-PSMA avid growth that is causing the rising CEA and it’s just not showing on the current scans.

[Tall_Allen]

I share your concerns. Those low PSA subtypes can be hard to treat. The Lu177 beta particles reach 125 cells in the area, so it might make a dent in the concordant non-PSMA-avid cells with continued use.

[climber1959 in reply to Tall_Allen]

Thanks so much for your prompt reply! I very much appreciate.

Do you have any thoughts about what might driving up CEA?

Again, thanks so much!

[Tall_Allen in reply to climber1959]

The tumors, probably.

[climber1959 in reply to Tall_Allen]

Thanks much!

[dhccpa]

I don't really ever having my CEA checked, even with a metastatic diagnosis 6.5 years ago. I didn't realize it was even used in PCa.

[climber1959 in reply to dhccpa]

Thanks much. More confirmation my case is unusual.

[j-o-h-n]

Make sure you ask your doctor if Keytruda (Immunotherapy) can be used for your Lung issues.

BTW Where are you located (city/state/treatment center)?

Good Luck, Good Health and Good Humor.

j-o-h-n

[climber1959 in reply to j-o-h-n]

sorry -I hit the wrong button. I live in Cary, NC outside of Raleigh. Have been treated at the Duke Cancer Center (Institute)

[j-o-h-n]

Great location, Great Hospital............(Nice area too)

I spent 6 months in Raeigh as a consultant for a bank in N.C. (Jogging up and down Capital Boulevard - when I could in those days). Keep posting here it's best for information and camaraderie.

Good Luck, Good Health and Good Humor.

j-o-h-n

[SteveTheJ]

FWIW, I have stage 4 prostate cancer even though my PSA got to a max of 3.4. More PSA doesn't necessarily mean more serious cancer.

[climber1959 in reply to SteveTheJ]

Thanks. Did they ever check your CEA?

[chips1942]

Hi, I also have PCa lung Mets & a low psa 0.04. Looking at a clinical trial at city of Hope - Actinium with a CEA Target. Take a look.

[climber1959 in reply to chips1942]

Thanks so much

[AlmostnoHope]

It's usually tumors that drive up CEA levels so check it out. I may not be from PCa. In me it was a Colon Cancer fungal tumor.

[climber1959 in reply to AlmostnoHope]

Thanks so much. I meet with my MO in three days. That will be a question!